Successful Chemoprophylaxis for<i>Pneumocystis carinii</i>Pneumonitis

TLDR

In a randomized, double‑blind, placebo‑controlled trial of 160 high‑risk cancer patients over two years, the authors evaluated trimethoprim–sulfamethoxazole for preventing Pneumocystis carinii pneumonia. The drug prevented all cases of Pneumocystis carinii pneumonia (0/80 vs 17/80 placebo, P<0.01) and reduced other infections, with oral candidiasis as the sole adverse effect, demonstrating high efficacy. Published in N Engl J Med 297:1419–1426 (1977).

Abstract

In a randomized, double-blind, placebo-controlled study to evaluate the efficacy of trimethoprim–sulfamethoxazole for the prevention of Pneumocystis carinii pneumonia, we studied 160 patients with cancer who were at high risk for this pneumonia over a two-year period. Seventeen of the 80 patients receiving a placebo acquired P. carinii pneumonitis, whereas none of the 80 given 150 mg of trimethoprim and 750 mg of sulfamethoxazole per square meter per day had the infection (P<0.01). Bacterial sepsis, pneumonia other than that caused by P. carinii, acute otitis media, upper-respiratory-tract infections, sinusitis and cellulitis occurred less frequently in recipients of the drug than in the placebo group (P<0.01 in each case). Oral candidiasis was the only adverse effect encountered from trimethoprim–sulfamethoxazole administration. The study shows the combination to be highly effective in the prevention of P. carinii pneumonitis. (N Engl J Med 297:1419–1426, 1977)